OR Connection Volume 8 Issue 1 by Medline Industries

The Aligning practice with policy to improve

patient care

Volume 8, Issue 1

Lean in Action in the OR

8 Ways

to Enhance the Patient Experience

No More Picking the Wrong Pack Special Section: EARN 1 FREE CE! Pages 29-40

End Nurse Bullying Now

Love & Recovery

Exclusive Interview with Giuliana & Bill Rancic Page 50

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Cover

Celebrity couple Giuliana and Bill Rancic, special guests at Medline’s Breast Cancer Awareness Breakfast during the 2013 AORN Congress in San Diego. Giuliana anchors E! News, the E! Network’s flagship entertainment news program, and often co-hosts red carpet events for award shows, such as the Golden Globes and the Academy Awards. Bill is a successful real estate developer who is famous for being Donald Trump’s very first “Apprentice.” Turn to page 50 for an interview with this dynamic pair.

Contents Editor Sue MacInnes, RD Senior Writer Carla Esser Lake Creative Director Michael A. Gotti Clinical Team Jayne Barkman, BSN, RN, CNOR Lorri Downs, BSN, MS, RN, CIC Margaret Falconio-West, BSN, RN, APN/CNS, CWOCN, DAPWCA Joan Ferrara, BA, RN, CNOR Kimberly Haines, RN, Certified OR Nurse Rebecca Huff, MSN, RN Angel Trichak, BSN, RN, CNOR Perioperative Advisory Board Garry Crawford, MS, RN, CNOR Norman Regional Health System, Oklahoma Evangeline Dennis, RN, BSN, CNOR, CMLSO Spivey Station Surgery Center, Georgia

Empowered to Improve. Learn how the University of Michigan is using the same “lean thinking” techniques as the auto industry to improve the delivery of health care.

NEW! EMPOWER Surgical Procedure Tray Packing System. Following an intensive research process, Medline applied the principles of intuitive visual design to create a new approach to surgical procedure trays.

Linda Groah, MSN, RN, CNOR, NEA-BD, FAAN Association of PeriOperative Registered Nurses, Colorado Darvina L. Heichemer, BSN, CNOR Gwinnett Medical Center – Duluth, Georgia Vivienne P Kaplan, RN Anaheim Regional Medical Center, California Colleen Mattioni, MBA, RN, CNOR Hospital of the University of Pennsylvania, Pennsylvania Julieann McIntyre, MSN, RN, CNOR South Shore Hospital, Massachusetts Susan A Miller, MSN, RN, CNOR St. Luke’s Hospital, Missouri Susan S Phillips, MSH, RN, CNOR UNC Hospitals, North Carolina Jo Quetsch, MA, RN, NE-BC Providence Sacred Heart Medical Center, Washington Eleonora Shapiro, BSN, MHA, CNOR Mount Sinai Medical Center, New York Pat Thornton, MS, RN, CNOR Southern Regional Medical Center, Georgia Judith A. Townsley, MSN, RN, CPAN Christiana Care Health System, Delaware Pat Thornton, MS, RN, CNOR

FREE CE!

Enhancing the Patient Experience. This series of three articles emphasizes the importance of the patient experience and shares initiatives you can implement in your OR.

Ending Nurse Bullying “Freire Style.” A fresh look at how to handle nurse bullying based on principles from sociologist Paulo Freire’s book, Pedagogy of the Oppressed.

About Medline Medline, headquartered in Mundelein, IL, manufactures and distributes more than 350,000 products to hospitals, extended care facilities, surgery centers, home care dealers and agencies and other markets. Medline has more than 1,100 dedicated sales representatives nationwide to support its broad product line and cost management services. ©2013 Medline Industries, Inc. The OR Connection is published by Medline Industries, Inc. One Medline Place, Mundelein, IL 60060. 1-800-MEDLINE.

Aligning practice with policy to improve patient care

Patient Safety

22 42

EMPOWER Surgical Procedure Tray Packaging System Improving Patient Safety and Efficiency with Barcode Technology

OR Issues

32 Eight Ways to Enhance the Patient Experience in Perioperative Services 34 The Rewards of Continuous Process Improvement

Page 7

Special Features

10 30 48 50

Empowered to Improve HCAHPS: More Than Just a Survey Ending Nurse Bullying “Freire Style” Q&A: Giuliana & Bill Rancic Inspire Audiences on Love & Recovery

Page 42

Regular Features

7 Surgical Safety News 9 Sterile Processing Corner: Creating a Shared Vision

Page 50

Caring for yourself 54 Sleep More…Sleep Better 62 Recipe: Fudgy Low Fat Brownies

Sleep more ... sleep better, page 54

4 The OR Connection I www.medline.com

Forms & Tools 64 Take the Best Route to Preventing Surgical Site Infections in Hip and Knee Arthroplasty 67 Pre-op Bathing 69 SBAR Scenario Development Sheet 70 SBAR Communication Tool

Page 62

The OR Connection Letter from the Editor

Dear Readers, If there was a place where you could almost guarantee sunshine, then it would have to be San Diego. And, how fitting…sunshine, promise, and the future…the perfect spot to have the biggest meeting of perioperative professionals in the country. Yes, 2013 is filled with promise. The committees who did all of the planning and behind-the-scenes work for AORN deserve a round of applause because they picked a prime location to spark enthusiasm, a renewed climate of optimism, and a vision of where we need to go. For the East Coasters it is a journey, but one to be remembered. For folks from the West Coast, it is a reunion. And, for me, who is in the middle, in Chicago, where it has been bitter cold ...I am so excited to see sun, feel warmth and mingle with so many talented people. It is worth the journey. Well done, AORN committee ... 2013 needed San Diego! At this meeting, we are delighted to be launching an innovation to “customary” surgical packs. After intensive research, Medline and its team of designers and clinicians have developed a “NEW” design for custom packs. Look at pages 22 to 27 to see and read about the details of the design and how it makes packs more efficient, simple and safer for the patient…another Lean solution to improve your operation. Thank you to everyone in the field who let us observe their practices, discuss current design concepts that created work-arounds for staff, provided honest feedback, and helped us test our concepts. Because of you, we have a solution that is well-tested and born from the very heart of what you do every day. You are our research lab! It seems that so much of health care is (as it should be) centered around our patients and their families. Having so recently been on the patient side, or you could call it more appropriately the “family” side, I have a deep appreciation for the term “patient experience.” So much so that the CE portion of this publication is all about the patient experience…often referred to as HCAHPS scores. It is a real concern and a burning issue at the top levels of your organization. Yes, patient experience is one of the top three priorities for organizations like ours, and yet, it is so difficult to wrap

our arms around. What will make a difference? And how can I be a part of that? You can read the CE articles and get your credits, but I think more importantly, because you have such an impact on these scores, you need to put yourself in the shoes of those you care for, or perhaps their families. As much as we try to make a science out of social or cultural interactions…it is really about treating human beings like human beings. And you have the power to do that, and mentor that, among other hospital workers. We really are just one big team. We’d love to hear what your organization is doing to improve the patient experience. So, why not share your stories and tactics? I’d be thrilled to publish your ideas in the next issue of The OR Connection. Email me at smacinnes@medline.com. Did you happen to notice who is on the cover of this issue? Giuliana and Bill Rancic! Yes, we are going to have another incredible get-together at our “pink carpet” event… Medline’s Breast Cancer Awareness Breakfast during the 2013 AORN Congress. And while we are at it, we are going to be showing footage of 2012 Pink Glove Dance videos and some behind-the-scenes footage of how the winning video was made. I hope you are there to join us in the making of a Pink Glove Dance Video to kick off the 2013 Pink Glove Dance Competition at Congress! If not, check out pinkglovedance.com and you will see 1,000 nurses dancing at 6 am. How cool is that? Maybe you were one of them. Finally, we are honored to have Janelle Hail, founder and CEO of the National Breast Cancer Foundation (NBCF), in attendance at the breakfast. To date, Medline has donated $1.2 million to NBCF. These funds are directed to nearly 100 prevention and early detection programs for women in need across the entire United States. Together, Medline and NBCF are helping save lives through education and free mammograms. All the best,

Sue

Follow on Twitter: @smacinne Connect on LinkedIn: Linkedin.com/in/smacinnes

Aligning practice with policy to improve patient care

Contributing Writers

Margaret Falconio-West, RN, APN/CNS, BSN, CWOCN, DAPWCA

After receiving her bachelor of science degree in nursing, Margaret Falconio-West continued post graduate work at the College of St. Francis and completed her WOC education at Emory University. She holds licenses in Illinois as a registered nurse as well as an advanced practice nurse. She is board certified as full scope of practice Wound, Ostomy, Continence Nurse(CWOCN) through the WOCN Certification Board. She has presented numerous scientific posters and papers at national symposiums and published many peer reviewed journal articles in the field of skin, wound and continence care. Michelle DeMeo

Michele DeMeo is an expert in the sterile processing field who is highly regarded for her management techniques, product development and contributions to various healthcare associations and professional publications. She is now tackling another important role – learning to live well in the face of a terminal illness. Renee Thompson, MSN, RN, CMSRN

Renee Thompson, author of “Do No Harm” Applies to Nurses Too, invites you to visit www.rtconnections.com for resources and free articles. Renee is a sought-after speaker, consultant and career coach in health care. She guides healthcare organizations and nurses to decrease nurse-to-nurse bullying, improve clinical and professional competence, effectively communicate, embrace social media, and create nurturing and supportive work environments. Wolf Rinke, RD, CSP

Keynote speaker, seminar leader, management consultant, executive coach and editor of the free electronic newsletter Read and Grow Rich, available at www.easyCPEcredits.com. In addition he has authored numerous CDs, DVDs and books including Make It a Winning Life: Success Strategies for Life, Love and Business, Winning Management: 6 Fail-Safe Strategies for Building High-Performance Organizations. Reach him at WolfRinke@aol.com. Lyudmila Weiss, MBA, BSN, RN

Lyudmila Weiss began her nursing studies in Belarus (one of the republics of the former Soviet Union) at Medical College Pinsk and worked as an OR nurse for four years at Emergency Hospital in Gomel, Belarus. She emigrated to Los Angeles in 1996 and graduated from Santa Monica College in 1999. She earned her BSN in 2011 and her MBA in 2012 from the University of Phoenix. Lyudmila has been the director of perioperative services at Olympia Medical Center in Los Angeles since 2010.

6 The OR Connection I www.medline.com

Surgical Safety News

Seven Most Common Risk Factors Related to Complications with Outpatient Surgery 1 According to research recently reported in Anesthesiology News, seven statistically significant conditions increase complications with outpatient surgery. Researchers at the University of Michigan selected the 150 most common outpatient procedures and reviewed more than 240,000 cases in a clinical database. They identified these seven risk factors: 1. History of cancer 2. Paraplegia/quadriplegia 3. Age 70 or older 4. History of renal failure/dialysis 5. Current steroid use 6. Chronic obstructive pulmonary disease (COPD) 7. History of cerebral vascular attack (CVA)/transient ischemic attack (TIA) The top five perioperative complications in people with these risk factors included unplanned re-intubation, post-op pneumonia, surgical site infection, intraoperative blood transfusion and inability to intubate.

SSIS decline 17 percent 2 Hospitals reduced surgical site infections (SSI) 17 percent between 2008 and 2011, according to a new report by the Centers for Disease Control and Prevention (CDC). Central line-associated bloodstream infections fell 41 percent during the same period. The findings are based on data from the CDC’s National Healthcare Safety Network, which includes hospitals

participating in the inpatient quality reporting program. To download a copy of the CDC report, go to http://www.cdc. gov/hai/pdfs/SIR/SIR-Report_02_07_2013.pdf

Signs That Warrant a Call to the Surgeon Following Colorectal Surgery3 Discharge instructions for colorectal surgery patients should include a list of specific symptoms that warrant follow-up with surgeons, according to a report in the February 2013 issue of the Journal of the American College of Surgeons. An 11-member panel composed of surgical oncologists, colorectal surgeons and general surgeons deliberated on the warning signs patients should watch for after being discharged home. They decided the following symptoms warrant calls to the operating physician: • Wound drainage, opening or redness (all three can indicate an infection) • No bowel movement or lack of gas/stool from any ostomy for more than 24 hours • Increasing abdominal pain • Vomiting • Abdominal swelling • High ostomy output and/or dark urine or no urine • Fever greater than 101.5 degrees F • Unable to take anything by mouth for more than 24 hours The panel also says patients should head to the nearest emergency department if they experience shortness of breath or chest pain. References 1. Wasek S. Outpatient surgery’s biggest risk factors. Outpatient Surgery E-Weekly. January 15, 2013. Available at: http://www.outpatientsurgery.net/newsletter/ eweekly/2013/01/15#5. Accessed February 13, 2013. 2. Centers for Disease Control and Prevention. 2011 National and State Healthcare-Associated Infections Standardized Infection Ratio Report. Available at: http://www.cdc.gov/hai/pdfs/SIR/SIR-Report_02_07_2013.pdf. Accessed February 13, 2013. 3. Li LT, Mills WL, Gutierrez AM, Herman LI, Berger DH, et al. A patientcentered early warning system to prevent readmission after colorectal surgery: a national consensus using the Delphi method. Journal of the American College of Surgeons. 2013; 216(2):210-216.e6.

Aligning practice with policy to improve patient care

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Sterile Processing Corner

Creating a Shared Vision by Michele DeMeo

Each year most hospital or surgical center executives request new goals. Sometimes goals have to shift mid-year due to an event or shift in something within your department or organization. This is not unusual. Having played the role of the process improvement manager for one facility for a period of time, I came to discover that we tend to work in silos. Departments throughout a facility rarely work on their unit’s goals with another department, unless an event occurs, and then they must collaborate after the fact. This is very different from what I am about to propose. If we limit this to just perioperative services and sterile processing, we can begin to develop a plan now. Creating vision is challenging. And working toward it is harder yet. However, at times we make it harder than it needs to be. We do this by not always inviting all the right people to the discussion table. If your vision is to have a surgical center of excellence, but you do not consider the SPD department as a component, you will be less likely to achieve your vision. The SPD department provides a major piece of the pie at the table. You can’t have it all if a piece is missing. Furthermore, both departments might have differing, counter-intuitive visions that work against the grain. SPD’s vision might be to ensure all surgical sets are properly processed by 11 pm, and the surgical department’s vision is to begin to open a third shift. Neither department shared their thoughts before your planning began, or worse yet, your beginning to initiate the steps of your goals without informing or involving the other department.

The question becomes, how do we create that shared vision? Here are two simple ideas to consider: • Begin, if you do not have a strong relationship with your sterile processing department, to work on that first. • Meet at first, privately, with the sterile processing manager or director and describe what you are envisioning for your unit or division. Then ask what SPD’s vision is. Compare them. Do they contrast or complement each other? If they don’t, try to understand, by soliciting their rational. There could be real operational issues that are hindering their workflow. With information, some process changing and your rationale shared, dialogue becomes initiated. From this point, you can move from perpendicular actions to running parallel with each other. From my experience as a consultant and sterile processing department manager, most want to work with you. We want to provide excellent service, but we are also, usually, the last to share information with. This is not only a roadblock for you, but frustrating for us. When unity is created, the ability to mirror vision is not so impossible. In fact, it likely will be one of your easier challenges.

Editor’s Note: This is the fourth in a series of 8 columns written by Michele DeMeo, a sterile processing expert with more than 20 years of experience in this field. Aligning practice with policy to improve patient care

EMPOWERED TO IMPROVE By Ian Demsky

What the making of world-class cars has taught us about

delivering world-class medicine This much is obvious:

People are not cars. Operating on a cancer patient — an individual, someone’s spouse, someone’s parent — is not the same as the assembly-line manufacture of identical coupes. 10 The OR Connection I www.medline.com

And yet,

the same “lean thinking” techniques that fueled Toyota’s global success in quality and market share are having a dramatic impact on the delivery of health care, and helping the University of Michigan to map a future of medicine that relies on new efficiencies and smart innovations to improve patient care and lower health care costs. Lean efforts — which reassess work to maximize value and learning while minimizing waste — have been under way at the U-M for several years, including initiatives that cut door-to-balloon times for heart attack patients, reduced the lengths of stay for critical care patients on ventilators, and improved access for new patients to the Urology Clinic. One recent project exemplifies the big impact that can come from looking at medicine through lean-colored lenses. For a year-and-a-half, Department of Otolaryngology Chair Carol Bradford (M.D. 1986, Residency 1992) turned her operating room into a laboratory — the first anywhere to apply the lean model to head and neck surgery. Not only were she and her colleagues able to identify about 75 hours of wasted time per year within her weekly block of two operating days, they showed that focusing on efficiency and profitability does not have to come at the expense of staff morale, surgical resident education, or care provided to patients. If the approach were extended to all 35 adult operating rooms over a fiveday work week, it could add as many as 6,500 additional hours of OR

Aligning practice with policy to improve patient care

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capacity each year and potentially millions in new revenue, according to the team’s study, which was published in the June issue of the Journal of the American College of Surgeons. “Most of the changes we made were actually pretty simple — like doing certain tasks simultaneously rather than in series,” says Bradford. “But simple things can pay big dividends.” The findings come at a time when hospital budgets — including U-M’s — have been strained by financial downturn, high rates of uninsurance and underinsurance, and potential impacts from changes to federal health care laws. “We’re entering an era where we have to be more and more mindful about how to deliver care safely, efficiently and effectively,” Bradford adds. “Efficiency is without question part of health care reform.”

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Going to the gemba The 1990 bestseller The Machine That Changed the World describes the difference between mass production and lean production as a “difference in goals.” Mass

production settles for being cost effective and “good enough,” while lean producers “set their sights explicitly on perfection” and continual improvement. At its core, lean thinking is about ensuring that each step of a particular process — in Bradford’s case, all aspects of an operation from the induction of anesthesia to the surgical dressing — adds value for the customer, no matter whether that customer is in a car dealership or a hospital bed. “Doctors and nurses already do this process in their clinical practice every day,” explains U-M’s lean guru John E. “Jack” Billi, M.D. (Residency 1981), professor of internal medicine and of medical education. They gather information about a patient’s problem, analyze it, and propose an intervention that treats the root cause of the issue, not just the symptoms. Then they monitor the outcome and adjust the strategy if necessary. “The only difference is that with lean the patient is the Health System,” says Billi, who heads the Michigan Quality System, the unit tasked with implementing lean across UMHS. MQS efforts are coordinated by an operations team and supported by seven full-time lean coaches and more than 20 additional part-time coaches embedded across various departments. Besides valuing the insights of front-line workers over top-down directives, leaders of lean-thinking organizations also spend time in the trenches observing firsthand the real capabilities and difficulties within an organization — a step known in the

lean idiom as “going to the gemba,” going to where the work is done. Adopting the lingo is one way of helping an institution become conversant with lean principles and to start to think in new ways. “Just yesterday I said to a colleague, ‘This isn’t working very well, better pull the andon cord,’” says Bradford, referring to the stop cord that every worker on the Toyota assembly line is empowered to pull when they see a problem. Above all, lean principles are stubbornly practical. “At first the idea that one would go and look at a problem, talk to workers about it, write down problems and dissect them to their root causes, and then address them one by one almost seemed too simple, too common sense,” says Michael W. Mulholland, M.D., Ph.D., the Frederick A. Coller Distinguished Professor of Surgery and chair of the Department of Surgery. But Mulholland’s initial skepticism of the lean approach was eclipsed after witnessing the success of projects like Bradford’s — which was a finalist for the 2011 National Lean Best Practice Award presented by the Institute of Industrial Engineers, where it faced competition from innovators at places like IBM, Xerox and Vought Aircraft Industries. “Every discrete improvement is cumulative,” notes Mulholland, who has been thinking a lot these days about the entire surgical “value stream,” where 10 major areas of improvement opportunity have

Aligning practice with policy to improve patient care

been identified. “Not to diminish its importance, but Dr. Bradford’s project is one piece of one of those big areas.” Moreover, the surgical stream has two siblings — acute medical care and ambulatory care — that are receiving similar attention.

Breaking open the black boxes The analysis in Bradford’s OR, spearheaded by the study’s first author, Ryan M. Collar, M.D. (Residency 2011), and lean trainer Mary Duck, began by mapping the actions and responsibilities for each of seven roles — from surgical faculty to scrub nurses, anesthesiologists to OR technicians — for every stage of an operation.

“Creating a team of people who trust each other and who can ask questions and work together as a team is probably the most important take-away from this process.” the challenges they routinely face. “It gives you renewed respect for the people you work with,” Healy says.

“I think many of us assumed the delays and problems we were experiencing were someone else’s fault,” says David Healy, M.D., assistant professor of anesthesiology and director of head and neck anesthesia. “Sometimes anesthesia is blamed for delays, but it’s like a black box — not many people know what it takes to get people ready and keep them safe before a surgical intervention. My view of the preparation happening inside the OR was the same way.

The “swim lane” mapping process also helped Sandra Feiner, R.N., communicate to her coworkers the importance for nurses of interviewing patients before they’re sedated, even though the work may at first appear redundant. “We’re doing one last double check of important documentation and making sure the patient is 100 percent ready for surgery,” says Feiner, who oversees care in the otolaryngology ORs. “Those few minutes while the patient is still awake is also our chance to get to know them a bit, meet their families, and reassure them they’re in good hands.”

“But by doing the timelines and working out who is doing what, when and why, we could actually see as a group where the issues really were.” The exercise helped each role to better understand the responsibilities of others, along with

Bradford echoes her colleagues’ sentiments. “It was freeing, actually, to all be pulling in the same direction,” she says. “Creating a team of people who trust each other and who can ask questions and work together as a team is probably the

14 The OR Connection I www.medline.com

most important take-away from this process.” The anecdotal evidence is backed up by data. The study measured staff morale, feelings of support, and thoughts about problem-solving on a five-point scale before and after the lean implementation. Progress was made in every category, with the composite score rising from 2.93 to 3.61 — an improvement of more than 20 percent. The research also surveyed surgical residents and found that the increased emphasis on efficiency did not have a detrimental effect on their education. More importantly, perhaps, they’ll carry their experience with lean philosophy into their future careers, says Bradford. In their search for valueless work, or muda, Bradford and her colleagues identified several places where time was being wasted. Each was relatively small and simple, but collectively made a significant impact. For example, time could be lost when anesthesiology faculty who were responsible for multiple rooms were not immediately available to induce a patient. Though not appropriate for every case, one underutilized option was to use the overhead paging system to call for another faculty member to assist. “Interestingly enough,” confides Healy, “that system already existed. The surgeons in the OR weren’t always aware it could be done and we anesthesiologists just assumed they knew about it. That’s one of the

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key things we learned — that we all probably assume too much.” Meanwhile, ORs were sitting empty between the completion of cleaning and the arrival of the next patient. “One of the easiest changes was to say ‘room ready’ about 10 or 15 minutes earlier so that the transportation could be done in parallel with the last part of the room preparation,” says Bradford. As a result, OR turnaround time — the time from the end of dressing one patient to the first incision on the next patient — fell from 89 minutes to 69 minutes. “When you’re doing several cases a day, that can make a huge difference,” she says. The time savings also led to financial gains from reducing by half the number of cases that finished after 5 p.m. and required overtime for hourly workers.

The right system, the right culture Although he wasn’t a doctor, what naturalist John Muir said of the entire universe is equally true of health care systems: When you try to pick out anything by itself, you find it’s hitched to everything else. Creating 6,500 hours of new operating room capacity would also require having enough inpatient beds for all those new patients. As problems are addressed, bottlenecks shift downstream: Work hard to fix delays and make sure all your

“We always go around and introduce ourselves by our first names,” explains Bradford. “In the OR, I’m Carol, not Dr. Bradford — even though some of my residents have a hard time getting used to that.” morning cases start on time, and you may discover they’re now backing up in the recovery room. “The U-M has been so successful that we don’t have enough beds and operating rooms to easily accommodate all the patients who want to come here,” Mulholland says. “So the top-priority projects within the surgical value stream deal with capacity, which can be improved by more efficient and coordinated use of our physical assets.” Going lean also means changing some of the traditional ways of thinking about medical practice. “Hierarchies are being flattened, and for good reason,” Mulholland says. “It’s a reflection of the world we live in. In the operating room there will always be differentiation. The anesthesiologist will put the patients to sleep, the surgeon will wield the scalpel, but they all share knowledge. One group is not smarter than any other group.”

“We always go around and introduce ourselves by our first names,” explains Bradford. “In the OR, I’m Carol, not Dr. Bradford — even through some of my residents have a hard time getting used to that.” Recently Billi, also associate vice president for medical affairs, got to see hospital operations from a new perspective. “It was really enlightening and humbling to actually be a family member of a patient,” he says. Billi observed nurses running back and forth because there wasn’t enough laundry, being diverted by call lights going off because meals weren’t delivered on time, and sorting things out after a patient’s X-ray was scheduled at the same time as a blood transfusion. “You have these nurses who are incredibly talented and capable, who are spending time doing these workarounds, and they probably don’t see them as workarounds because it’s been the standard way of getting the job done,” he says. “We have a fantastic health system,” Billi continues. “My family gets all of their medical care here. I moved my parents here so my father could have a hip replacement. And yet, like every health system in the country, we have challenges. We need to be honest about them and try to understand their causes — and then not bring in experts to fix them, but help the front-line workers find and fix the root cause of the most important

Aligning practice with policy to improve patient care

problems because they know the work the best.” Billi points to the long-term savings that came from something as simple as adding drawer dividers and reorganizing a single supply cart used for peripherally inserted central catheter lines. “The estimate is that it saves a nurse an hour a day — every PICC team nurse, every day, for the rest of time,” he says. Since 2009, more than 200 “everyday lean” ideas have been put into practice. The U-M received coaching on its first few lean initiatives from General Motors, which itself had come to realize the value of lean principles, but coaching will never get the U-M where it needs to go, says Billi. “That might work if we had three problems, but if you have 22,000 workers and each one touches a dozen processes and each process has a dozen problems, you can never hire enough coaches to help. Who has to fix these problems? The workers themselves.” But the lean approach doesn’t attempt to tackle the existing culture head-on, according to Billi. “Within lean thinking, the concept of culture is really important. But culture is a result of the right processes.

18 The OR Connection I www.medline.com

If you want a culture that empowers workers to solve problems, you don’t get a culture transplant — the right system will build the right culture. If you want a culture that empowers workers to solve problems, you don’t get a culture transplant — the right system will build the right culture. “Toyota’s leaders have said they combined average workers with brilliant processes to produce superb work,” Billi says. “We have brilliant people at the U-M. Imagine what we can do when we make our processes equally brilliant.”

Reprinted with permission from Volume 14, Issue 2 (Summer 2012) of Medicine at Michigan. This permission does not constitute an endorsement of Medline Industries, Inc. or its products by the University of Michigan.

Join 320,000 other clinicians for FREE CE courses at

Medline University w Over 220 courses w 22 curriculum tracks w Interactive competencies w Flexible access: PC, iPhone, iPad w Free registration

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ÂŠ2013 Medline Industries, Inc. Medline and Medline University are registered trademarks of Medline Industries, Inc.

Waste Reduction Value-Based Purchasing Accountable Care

SCIP measures

Patient-Centered Care

Culture of Safety Health Care Reform

What keeps YOU up at night?

Medline is listening. EMPOWER is a comprehensive methodology to help healthcare leaders transform their OR through education, action, and outcomes.

Education  On-Site CE Education Staff Safety Survey  New Course Curriculum by Industry Leaders  Customized Medline University Web Page

Action  Safety Solutions  LEAN Analysis  greensmart™  Cost Reduction Program  NEW! Surgical Packs

Outcomes  Outcomes Report  Business Reviews  Identification of New Education Needs

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22 The ORâ&#x20AC;&#x2C6;Connection I www.medline.com

Following an intensive research process, Medline and its team of designers and clinicians applied the principles of intuitive visual design to create a new approach to surgical procedure trays: Medline’s EMPOWER Packaging System. The user-centered system improves the ease, efficiency and safety of your surgical procedure trays.

Key Benefits



Increase the speed and efficiency of stocking and picking



Prevent the inconvenience and expense of pulling the wrong pack



Easy identification of latex items to reduce the risk of accidental latex exposure

Support your hospital’s Lean OR objectives 



Larger font and alphabetical description allows for easier reading of outer label

Clear expiration date for easier reading and less chance of using  expired supplies

WHO Surgical Safety Checklist included inside each pack 

Aligning practice with policy to improve patient care

A look at common problems with custom packs If you take a moment to analyze the surgical procedure trays lining the shelves of your central sterile supply room, you are likely to discover many of the same issues Medline found in its analysis conducted at hundreds of hospitals across the United States:

Size and Shape

• Packs come in several sizes, so shelves are difficult to keep organized • Packs are bulky and not easy to store; sometimes they are crammed into shelves making them hard to pull out • Edges are not well defined and overall shape is clumsy • Lack of structure allows packs to fall or slide off shelves Packaging Labels

• Hard to read • Not always located in the most visible position Pack Inserts

• Very few staff members read the insert • Difficult to identify important information such as contents, expiration date or if any items contain latex

24 The OR Connection I www.medline.com

Picking the wrong custom pack A bigger problem than you might think In a recent survey of hospital OR staff conducted by Medline, respondents were asked to comment on the incidence and implications of incorrect pack picks. Here are the results:

63% Wrong pack picked several times per year 11% Wrong pack picked several times per month 51% Incorrectly picked packs discarded 71% Custom packs containing items that are routinely wasted or discarded 93% Sometimes or never read the pack insert

When the wrong pack is picked, 83% of respondents either: Scrap the pack and pull a new one.

Pull additional separate sterile items. This results in decreased staff productivity and increased case cost.

Aligning practice with policy to improve patient care

What you see is what you get Eliminating confusion through Intuitive design

Increase efficiency and patient safety Each EMPOWER surgical procedure pack is color-coded according to the type of surgery (e.g., ortho, neuro) and labeled with large, legible lettering indicating the specific procedure, so you’ll know right away that you’re picking the right pack.

2 6

3 1

X X

Lap chole 4OR towels 1 Suction irrigation system

A Closer Look at the Redesigned Packing List 1 Highly legible alphabetized pack list lets you verify contents before opening pack

Customize inserts with your hospital logo

3 Clear expiration date 4 Latex items are noted in red – an almost impossibleto-overlook alert that helps prevent accidental exposure

5 Component utilization tool helps improve pack efficiency and eliminate waste by documenting unused items that may be eliminated, and additional separate sterile items that should be added to the pack. 6 WHO Surgical Safety Checklist

Behind the Design

An interview with Deborah Adler Medline partnered with innovative designer Deborah Adler, principal of Deborah Adler, LLC, to help redesign its custom surgical procedure packs in an effort to reduce staff errors when picking, make the packs easier to pick from the supply room, save time and enhance patient safety. It sounds like a tall order, but always at the heart of Deborah’s work is the belief that design can change people’s behavior. Prior to forming her firm in 2008, she designed a comprehensive system for packaging prescription medicine. Her inspiration was her grandmother, Helen, who accidentally swallowed her husband’s medication because she could not clearly identify her own pill bottle among all the bottles in her medicine cabinet. Fortunately, Helen was not severely harmed by the accident. And Deborah’s packaging redesign resulted in a completely reinvented pharmacy experience. She brought this innovation to Target®, and together they developed the award-winning ClearRx® system. Adler also helped Medline develop educational packaging for its line of advanced wound care products. In a study involving 139 nurses at eight different facilities, 88 percent who used a wound care product with an education guide attached were able to apply the dressing to the wound correctly.1 When it came time to redesign its custom surgical procedure packs, Medline once again approached Adler. “Medline designers and clinicians and I spent hundreds of hours in hospitals across the United States, observing and interviewing central supply managers, OR directors, surgeons, nurses, scrub techs and others about their surgical procedure packs. We found that there’s a different pack for every type of surgery, but they all look basically alike. They’re all bulky and blue – a big blue wall in Central Sterile Supply,” Adler said. After analyzing all aspects of the surgical procedure packs out in the field, taking into account size and shape, labeling, packing lists and staff usage, Adler and her team developed the EMPOWER Surgical Procedure Tray Packaging System. “We applied the principles of intuitive visual design to every aspect of the system. The result: Packaging that’s uniquely conducive to rapid, accurate comprehension, ease of use and lower margin for error,” Adler said. References 1. Kent DJ. Effects of a just-in-time education intervention on wound dressing packages. Journal of Wound, Ostomy, and Continence Nursing. 2010;37(6):609-614. ©2013 Medline Industries, Inc. All rights reserved. EMPOWER is a trademark and Medline is a registered trademark of Medline Industries, Inc. ClearRx and Target are registered trademarks of Target Brands, Inc.

Aligning practice with policy to improve patient care

MEDLINE’S REVOLUTIONARY SHOW-AND-TELL PACKAGING

Each package is a 2-Minute Course in Advanced Wound Care ™

Medline’s Educational Packaging offers all the information you need, step by step, short and sweet, to help the Medline dressing do its job of healing. In a study involving 139 nurses at eight different facilities, 88% who used a wound care product with an education guide attached were able to apply the dressing to a wound correctly.1

http://goo.gl/jrMHa Reference 1. Kent DJ. Effects of a just-in-time education intervention placed on wound dressing packages. Journal of Wound, Ostomy and Continence Nursing. 2010; 37(6):609-614. ©2013 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.

Read the following three articles, and then visit www.medlineuniversity.com and login or create an account. Choose your course to take the test and receive 1 FREE CE credit.

Special CE Section â&#x20AC;&#x201C; Pages 23-33!

the

Enhancing Patient Experience The articles in this section describe ways to improve the patient experience while engaging in continuous process improvement, maintaining excellent patient care and earning good HCAHPS scores.

PG 30

CAHPS: More Than H Just a Survey

PG 32

Ways to Enhance the 8 Patient Experience in Perioperative Services

PG 34

he Rewards of Continuous T Process Improvement Department of Perioperative Services, Olympia Medical Center, Los Angeles

Aligning practice with policy to improve patient care

CE Article 1 of 3

HCAHPS: More Than Just a Survey The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national, publicly reported tool developed by the Centers for Medicare and Medicaid Services (CMS) and Agency for Healthcare Research and Quality (AHRQ). It has been around for a while, with voluntary data collection beginning in 2006, and the first public reporting in 2008 at www.medicare. gov/hospitalcompare. In the past, the scores were simply guidelines to help consumers choose a hospital, but there were no penalties for hospitals that scored low. Today, however, with the enactment of the Affordable Care Act and Medicare’s value-based purchasing program, HCAHPS scores are beginning to affect hospitals’ finances. Starting in 2013, one percent of hospital reimbursement will be held back if HCAHPS scores either fail to meet standards or do not improve from one year to the next. Penalty withholding will continue to increase over time until it reaches two percent in 2017.1 A random sampling of patients receives an HCAHPS survey by phone or in the mail after being discharged from the hospital. The survey contains 18 substantive items that encompass critical aspects of the hospital experience, patient rating items that encompass eight key topics and two overall rating questions.2,3

The HCAHPS Survey Key topics 1. Communication with doctors 2. Communication with nurses 3. Responsiveness of the hospital staff 4. Pain management 5. Communication about medicines 6. Discharge information 7. Cleanliness of the hospital environment 8. Quietness of the hospital environment

Overall Ratings 1. Overall rating of the hospital 2. Willingness to recommend the hospital to family and friends

As you can see, the questions are broad and can apply to any area of the hospital where the patient receives care, making it important for all hospital staff to be stewards of the patient experience.

References 1. Saver C. HCAHPS: How the OR’s scores affect your whole organization. OR Manager. 2011; 27(4). Available at: http://www.pressganey.com/Documents/News%20 Articles/ORMVol27No4ORandHCAHPSScores.pdf?viewFile. Accessed February 12, 2013. 2. HCAHPS. Centers for Medicare & Medicaid Services, Baltimore, MD. Available at: http://www.hcahpsonline.org. Accessed February 12, 2013. 3. Patients’ survey. Medicare website. Available at: http://www.medicare.gov/hospitalcompare/Data/patientsurvey/overview.aspx. Accessed February 12, 2013.

30 The OR Connection I www.medline.com

For the warmth and safety of your patients.

Underbody Warming for All Patients and Procedures For protection from unintentional hypothermia in patients undergoing surgery, PerfecTemp is an excellent alternative to forced-air warming systems. While other systems use disposable blankets to force warm air on top of patients, PerfecTemp’s unique surgical table pads offer: Flexible and durable carbon heating element for uniform heating.

• Efficient underbody warming as effective as forced-air systems for preventing unintentional hypothermia1 (SCIP Measure #10) • Pressure redistribution to aid in pressure ulcer prevention (CMS Hospital-Acquired Condition) • Complete patient access • Silent operation • Reduced staff time • No blowing air

1-800-MEDLINE I www.medline.com PerfecTemp is custom-fit to your table configuration. Ask Medline for a free quote.

PerfecTemp™

OR Patient Warming System Reference 1. E gan C, Bernstein E, Reddy D, et al. A Randomized Comparison of Intraoperative Warming With the LMA PerfecTemp and Forced Air During Open Abdominal Surgery. ©2013 Medline Industries, Inc. Medline and PerfecTemp are registered trademarks of Medline Industries, Inc.

Ways

CE Article 2 of 3

to Enhance the Patient Experience in Perioperative Services Margaret Falconio-West, RN, APN/CNS, BSN, CWOCN, DAPWCA

Although at first it might not seem that perioperative services would be affected by HCAHPS, if you look carefully at the survey questions, most of them do apply. In addition, patients who have a good experience in your OR are likely to return and/or refer friends. Some experts believe that this referral piece will have more impact on a hospital’s financial future than the reimbursement penalties being implemented by Medicare.1 What’s more, patients say the non-clinical experience is twice as important as the clinical excellence when choosing a hospital, as described in a 2010 New England Journal of Medicine article, “The Emerging Importance of Patient Amenities in Hospital Care.”1 So, how can perioperative services staff help raise HCAHPS scores? The following are ideas that have worked in ORs across the country. 1. Provide excellent communication, especially during handoffs. Communication with the patient and your colleagues is important every time you hand off the patient to another staff member. For example, be sure to tell the patient what to expect when you transition him from pre-op to the operating room. Also, provide detailed communication to the next caregiver regarding your patient and his condition. Tools such as SBAR (Situation, Background, Assessment, Recommendation) help staff remember everything they need to relate to the next caregiver and emphasize consistent and detailed communication.1,3

32 The OR Connection I www.medline.com

2. Keep families informed. Even though family members and other loved ones do not complete the HCAHPS, how they are treated can influence how the patient answers the questions on the survey. Many hospitals make it a point to obtain loved ones’ phone numbers so the OR circulation nurse can contact them every hour with patient updates. Similarly, post anesthesia care unit (PACU) nurses notify families if recovery is prolonged.1

3. Educate patients early and often. Be sure to explain to the patient everything you and your staff will be doing at each step, including what kind of procedure they will be undergoing, how much pain to expect, what kinds of medication you will be giving and instructions for aftercare at home. Patients that understand more about their care and condition feel more engaged in the process and less nervous. Phrases such as, “my nurse explained to me…” and “the doctor sat and talked with us…” are associated with high HCAHPS scores.2

4. Acknowledge patients’ anxiety. Many patients are nervous right before and after surgery, especially if this is their first surgical experience. Realize that they might not be in their most pleasant state of mind and do your best to ease their fears.3

6. Hire exceptional people. In most cases, compassion is something people are born with, and it can be difficult to teach. When hiring staff, examine their “soft” skills as carefully as their clinical expertise.3

5. Give extra attention to older patients. More and more, a greater percentage of patients are elderly, and they may need more assistance. Speak slowly and clearly to make sure these patients understand your instructions.3

7. Ask for suggestions from your staff. Try to maintain open communication among staff so they are comfortable sharing their ideas for improving the patient experience. You can gain a wealth of knowledge from staff who are willing to share success stories from other hospitals where they have worked.3

8. Use patients’ feedback to improve the patient experience. Act on problem areas that come up often on survey results or when talking with patients in person. For example, if there is a problem with uncomfortable beds, and the issue is lack of staff training on how to adjust the beds, implement an in-service to educate staff and see if the problem disappears from surveys. If not, take another approach until the problem is solved.2 References 1. Saver C. HCAHPS: How the OR’s scores affect your whole organization. OR Manager. 2011; 27(4). Available at: http://www.pressganey. com/Documents/News%20Articles/ORMVol27No4ORandHCAHPSScores.pdf?viewFile. Accessed February 12, 2013. 2. Rodak S. 4 strategies to boost hospitals’ HCAHPS scores. Becker’s Clinical Quality & Infection Control. September 4, 2012. Available at: http://www. beckershospitalreview.com/quality/4-strategiesto-boost-hospitals-hcahps-scores.html. Accessed February 13, 2013. 3. Page L. 8 ways to enhance patient satisfaction in surgery centers. Becker’s ASC Review. March 29, 2011. Available at: http://www.beckersasc.com/ asc-turnarounds-ideas-to-improve-performance/8ways-to-enhance-patient-satisfaction-in-surgerycenters.html. Accessed February 13, 2013.

Aligning practice with policy to improve patient care

CE Article 3 of 3

The Rewards of

Continuous Process Improvement Department of Perioperative Services, Olympia Medical Center, Los Angeles by Lyudmila Weiss, MBA, BSN, RN

Editor’s note: Medline’s Perioperative Supply Management Consulting Services team works closely with hospitals to assess current supply management practice and eliminate unnecessary waste in the OR. Through these engagements we look for new ways to improve physician and staff satisfaction and productivity, giving staff more time to focus on patient care. While recently working with Olympia Medical Center in Los Angeles, CA we observed some extraordinary work that they are doing to drive continuous improvement in their organization.

34 The OR Connection I www.medline.com

Aligning practice with policy to improve patient care

Have you ever

waited in the visitors’ lounge for a family member, significant other, or friend who was undergoing a surgical or diagnostic procedure? Did you sit, wonder and worry, with no one providing updates about what was going on?

Informing visitors every hour This was a common scenario at our Los Angeles hospital, Olympia Medical Center, until about a year and a half ago when our perioperative services management team, in collaboration with Joanne Bayless, director of service excellence, decided to pilot a new process. Our goal was to give visitors hourly updates on ambulatory surgery patients by phone or in person. Initially we informed visitors when the patients were in the surgical or diagnostic procedure. Later we realized there could be a long gap before the patient actually entered the procedure room because of delays with prior cases, the need for more pre-op work, physicians arriving late, and a number of other reasons. Therefore, we expanded our process with an hourly visitor’s update from the time patients arrive at the hospital’s admitting department and continuing until they are discharged from the facility or transferred from a recovery room to any other unit within the hospital. While this process may appear fairly easy, it took some time and much work to implement and see the results.

36 The OR Connection I www.medline.com

First we had to gain buy-in from staff, including admitting clerks, surgical transporters, and nurses from all the units of perioperative services, and then train them. The biggest challenge was to persuade operating room circulating nurses. They resisted the new process, giving a number of excuses, such as they were too busy as it is and they would not remember to do it hourly. They also questioned why they would need to give updates during short procedures like cataracts and suggested that someone at the front desk give the updates. My favorite excuse was it is just impossible. We made sure to give attention to each reason, and we refuted them all one at a time. Yes, we are very busy, but on average it takes only a couple of minutes to make a phone call. In order to keep track of every hour in the busy operating rooms, Mark Ganjianpour, MD, chief of surgery, suggested providing staff with alarms. They would go off hourly and remind everyone in the OR that it was time for a patient update. Yes, the procedure may take only 20 minutes, but the patient might be

Continuous process improvement flow Identify the problem

Gain buy-in from staff

Find resolution for any reasons for opposition

Determine “is it impossible?”

Gather data

Analyze data

Collaborate to improve the process based on the data

waiting in the pre-op area for an hour or more because the prior case took longer than expected. A person at the front desk cannot provide patient updates because that individual is not taking care of the patient – the circulating nurse is. Finally, how did we address “it is impossible”? We simply continued to show data from our star nurses and customer service satisfaction scores over and over, proving that yes, it is possible! I want to emphasize the importance of collecting data and constant follow up. In order to keep track of the process, we created a “Keep Families Informed Hourly” form. At first the forms were white, but they tended to get lost in the midst of other paperwork, so we changed them to bright green. The forms were collected daily, and then we gathered and analyzed the data, which was presented monthly at the Surgery Action Committee Meeting. The team worked collaboratively to perfect the process based on the data. We met individually with incompliant staff to find out what was needed, how we could help them follow the process, and most significantly to emphasize the importance of it.

As a result of our efforts, Olympia Medical Center was presented with an Honorable Mention for Hourly Rounding in Ambulatory Surgery for the year 2011. Also, our customer service satisfaction scores for visitors and family significantly improved.

team. I was very proud to report, “Yes they were – every hour!” Lastly, the best outcome of all is our visitors in the waiting room no longer need to wonder and worry about what is going on with their loved ones because they know an update is just an hour away.

The Surgeons Exit Interview

Our visitors in the waiting room no longer need to wonder and worry about what is going on with their loved ones because they know an update is just an hour away.

I recently received an email from Joanne Bayless to check if family was updated during a procedure that was performed at night with an on-call

Our newest process is called the Surgeons Exit Interview. During the last year many hospitals in the area, including ours, began experiencing a decline in surgical procedure volume. At that time a physicians’ satisfaction survey was taken, and the areas identified for improvement were staff competencies, OR turnover time, availability of equipment, instruments and supplies, and the OR team’s ability to address surgeons’ needs. First, we made an attempt to address all these issues in general. When business development representatives followed up, surgeons kept bringing up the same issues. Another dilemma was that the complaints were not specific, making it difficult to wrap our brains around them. For example, by the time we would receive a report from the business development department, we

Aligning practice with policy to improve patient care

The Surgeons Exit Interview is the perfect time to find out how the case went, answer questions and make changes and improvements.

Surgeons Exit Interview 1. Did the case start on time? 2. Did the case meet your expectations? 3. W as your preference card followed and any requested supplies, instruments and equipment ready for use? 4. Did you have any problems with equipment or instruments? 5. D id the team assigned to your room anticipate your needs and have everything ready for use without prompting or extensive direction? 6. A ny additional requests for your upcoming cases? 7. I s there anything else you would like to discuss? Continued on page 40

38 The ORâ&#x20AC;&#x2C6;Connection I www.medline.com

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would not necessarily know when the case had been performed or what kind of procedure it was. Nor did we know which equipment or instruments were missing or which team was assigned to the room. Moreover, it was hard for business development representatives to gather specifics because they did not have clinical background.

physicians know about equipment updates and speak to requests they may have. Staff is interested to hear what surgeons have to say and gives them a chance to know how well they are doing or if there is room for improvement, learning opportunities, in-services, or if they are a great team and doing an amazing job.

We knew we had problems, but we lacked details to help us solve them. Complaints kept coming in, and we needed to find a way to address them. Karen Knueven, MSN, RN, chief nursing officer and a great mentor and supporter, suggested talking to each physician before he or she exits the surgery department.

We are now aware of the specific concerns we can address in real time, and as the leader of the department, I can let physicians know it will be done. Many times surgeons come and

We put together the â&#x20AC;&#x153;Surgeons Exit Interviewâ&#x20AC;? questionnaire, which covers case start time, turnover time, preference cards, equipment, instrumentation, supplies, team competencies, and any additional requests. The process was for the circulating nurse to call the OR director at the completion of the case to interview the physician. This new practice provided results immediately. I was able to address a number of simple issues before the end of my working day. If any items were missing on the preference card, the OR team is responsible for fixing them during the case or by the end of the shift. Purchase orders for additional or missing instruments are generated the same day as well. The interview is also a way to let

END of Special CE Section

My biggest reward was when I came to work on Monday and one of our general surgeons, Ricardo Navas, MD, came to see me. He handed me a list of what needed to be addressed regarding the case he did over the weekend because I was not there to interview him. Fifteen years in surgery has taught me a few things, and one of them is doctors like attention, and they need to be heard. We all know how important effective communication is in business because it gives everyone the opportunity to share information and express their thoughts.

These practices, along with continuous process improvement, help us increase patient and physician satisfaction, both of which are increasingly significant for hospitals to sustain in the current healthcare environment.

do their cases without an opportunity to see or have direct contact with OR directors and address their experiences. The exit interview is the perfect time to find out how the case went, answer questions, and make changes and improvements. Sometimes it is just nice to have a conversation or wish a doctor a wonderful day. Furthermore, this is a perfect time to develop better working relationships and most importantly to let physicians know we care about their business with us.

These practices, along with continuous process improvement help us increase patient and physician satisfaction, both of which are increasingly significant for hospitals to sustain in the current healthcare environment. This also assists patients and surgeons in choosing their hospital and having positive experiences. The key is effective communication. Small, simple changes can make a big difference and provide desirable results.

Now that you have read the three articles, visit www.medlineuniversity.com and login or create an account. Choose your course to take the test and receive 1 FREE CE credit. Course is approved for continuing education by the Florida Board of Nursing and the California Board of Registered Nursing.

40 The ORâ&#x20AC;&#x2C6;Connection I www.medline.com

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oney-back guarantee – if you are not M completely satisfied with the your outcomes, we will provide a refund. ©2013 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc.

• Average reduction in facility-acquired pressure ulcers: 72.6%1 Source: 1. Data on file

1-800-MEDLINE l www.medline.com The only way to get PUPP - and PUPP results - starts with a call to Alice Kiehl, PUPP Program Manager, 847-949-2294.

42 The ORâ&#x20AC;&#x2C6;Connection I www.medline.com

Improving Patient Safety and Efficiency with Barcode Technology By Dave Rolston, Vice President, E-Business, Medline Industries, Inc.

The grocery industry has had it since the 1970s. It’s what allows consumers to scan items in the self checkout line. The acceptance of an industry-wide universal product identification system using barcode technology is a long time in coming to healthcare industry, and Kaiser Permanente, along with other major healthcare systems, are helping drive early adoption of GS1® Standards across the U.S. healthcare system. Kaiser is one of five U.S. healthcare systems, including Geisinger Health System®, Intermountain Healthcare®, Mayo Clinic® and Mercy®, who formed a collaboration called the Healthcare

Aligning practice with policy to improve patient care

Sterillium Rub: Faster Rub to Glove No More Sticky Hands

Exceeds FDA Requirements1

Sterillium Rub Waterless Surgical Scrub evaporates quickly for faster OR preparation. Emollients leave hands feeling soft and silky — never sticky or tacky — minimizing friction and skin trauma when donning gloves. It’s also CHG, latex and non-latex compatible.

Sterillium Rub is the only waterless, brushless surgical scrub with 80% (w/w) ethyl alcohol — the highest alcohol concentration of any surgical rub available in the US. Its long-lasting, persistent effect exceeds FDA requirements for surgical hand antisepsis. Sterillium Rub provides a rapid and comprehensive kill of transient and resident skin flora, with a 6 log reduction within two minutes.2

For more information on Sterillium Rub, contact your Medline representative, visit www.medline.com or call 1-800-MEDLINE.

1. Topical Antimicrobial Drug Products for Over-the-Counter Human Use; Tentative Final Monograph for Health Care Antiseptic Drug Products, 59 FR 31042 (1994) (to be codified at 21 CFR 333) 2. Data on file

Transformation Group (HTG), to share best practices and drive needed positive change across the healthcare supply chain. The group’s first initiative is the implementation of GS1® Standards to meet the FDA’s upcoming Unique Device Identification (UDI) requirements. “With the help of companies like Medline we are now starting to implement GS1 data standards at the point of care in our operating rooms,” said Michael Innes, a program director in Kaiser’s National Supply Chain Group. “Without the GS1 standards, it is difficult and time consuming to capture information for medical devices and implants into the Electronic Healthcare Record (EHR). In addition to population of the EHR, the UDI will be used to facilitate the recall of devices and implants where leveraging this standard will expedite the recall process.” Medline, a top supplier for Kaiser, is accelerating the use of the GS1 GTIN data standard barcode, which is now on more than 80 percent of the products used at Kaiser. The GTIN identifies an item uniquely so a manufacturer, distributor and provider are all using the same item number for a particular product. Kaiser’s

clinicians scan the GTIN barcoded products in the operating room with hand-held barcode scanners like you see in a grocery store. The scan identifies a unique number that goes into the hospital system’s electronic item master and pulls other information such as unit of measure, product description, price and a host of other details that go on a patient’s electronic health record and are also used for patient billing. Today, there are multiple standards and multiple barcodes on a product, which makes it

difficult for a clinician to know which label to scan. The GTIN puts one standard barcode on the product, which saves a clinician significant time in scanning items, improves information accuracy and enhances operational efficiencies. Kaiser estimates that by the end of 2013, enforcement of compliance among its top suppliers will result in about 70 percent of its OR inventory being GS1 compliant. Product will have a physical GTIN barcode affixed to it at the lowest unit of use, as well

Aligning practice with policy to improve patient care

as the corresponding product data being delivered through the Global Data Synchronization Network (GDSN®), with the goal of increasing compliance to 80 percent by end of 2014. In addition to improving efficiency in the OR and enhancing patient safety with more accurate and speedier methods to track recalled products, the GTIN will help to standardize the information that is fed into national and international clinical data bases and registries. These databases capture information from electronic medical records, including products used in a procedure, and associate them back to the clinical outcomes for a given procedure and patient to help determine the efficacy of the product.

46 The OR Connection I www.medline.com

“Manufacturers and distributors need to understand that their product information has a much bigger impact than what is traditionally viewed, which usually consists of getting it to the dock door or central OR storage,” said Innes. “That information lives many years beyond the procedure or even the life of the product itself and can involve improving patient outcomes, and potentially help save lives if a product recall is involved.” Ultimately, Innes, says, the product data captured for each procedure will enable the healthcare industry to conduct more accurate studies on clinical outcomes by understanding the right products to use for the right procedures at the right price.

“Right now we are not optimizing the use of our data. Rather, we are spending a lot of time just trying to figure out if we have the right data and determining if we have the same product ID for two completely different items,” he said. “When GS1 data standards are fully implemented, that effort can be better spent actually analyzing that data and associating it with outcomes.”

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Medline University Education for Surgical Techs now trending worldwide Medline University continues to build its curriculum of Surgical Tech courses, available at medlineuniversity.com Earn free CE credits with the following courses and more: • #2 on the Joint Commission List - Retained Foreign Objects • 9 on the Line to Improve Patient Safety • Applying Evidence-Based Information to Improve Hand-off • Communication in Perioperative Services

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Ending Nurse

Bullying “Freire Style”

48 The OR Connection I www.medline.com

“Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars ... Hate cannot drive out hate: only love can do that.”

– Martin Luther King, Jr

Bully-proofing “Freire Style” Freire suggests the following steps for the oppressed (victim of bullying):

Nurse bullying is a problem. But is it a new problem? The answer is no. Humans treating humans with disrespect has been documented since we walked on four feet instead of two. I’m sure there is a caveman drawing somewhere depicting bullying behavior. Although I’d like to believe we’ve evolved a bit since the caveman era, humans treating humans badly still exists. It’s no different in the nursing profession. However, bullying just seems more perverse in a profession dedicated to caring and compassion. It just doesn’t make sense. How can nurses, who are equals, pick on each other? Isn’t nursing challenging enough without having our own peers making it worse? I just don’t get it. Neither did Paulo Freire, a sociologist, who spent time in various countries observing human behavior. Dr. Freire witnessed people oppressing each other – peers oppressing peers – not administration/government oppressing the people. In his book, Pedagogy of the Oppressed, Dr. Freire offers us a solution to oppression by taking an in-depth look at the dynamics between the oppressor and the oppressed. I took the liberty of adapting his recommendations to nurse bullying.

1. Reflect Reflecting is the ability to analyze our own behavior and the behaviors of others in an objective way. If you find yourself in a bullying situation, spend time in deep thought about the situation. Increase your awareness of your behavior and the behavior of your oppressor. Can you identify patterns and triggers? What is your reaction when the bad behavior occurs? Pretend that you are an observer who bears witness to bullying attacks. What do you see? 2. Praxis This refers to skill development. The ability to stop the oppressor requires enhanced communication skills, an understanding of human behavior and the ability to then apply that learning into practice. Dealing well with nasty people isn’t intuitive. But the good news is that communicating in a way that decreases the bully’s power over you is a skill that can be learned. I know because I teach communication skills. 3. Rehumanize yourself It’s time for you to stop allowing other people to make you feel terrible about yourself. Stop giving power to the oppressor. Think of yourself as Norma Rae. Even if you have to stand up on a table and shout, “I’m NOT

going to take this anymore!!!” BELIEVE that you deserve to be treated with respect as a human. BELIEVE that you deserve to work in a supportive and nurturing environment. BELIEVE that you are a good nurse. My favorite quote of all time is by Eleanor Roosevelt: “No one can make you feel inferior without your permission.” Stop giving the bullies power over you. 4. Rehumanize your oppressor What? Be nice to my oppressor? Yes. Remember, kindness begets kindness. While I’m not asking you be lovey dovey with the bully, I am asking you to treat others (even the bullies) with kindness, compassion and respect. SOMEONE has to demonstrate that humans have evolved since the caveman era. It starts with each one of us. Another amazing quote that speaks to rehumanize your oppressor comes from the late Martin Luther King, Jr. who said, “Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars ... Hate cannot drive out hate: only love can do that.” Remember, you deserve to work in a nurturing and supportive environment, free from the bullies. Doing that requires that we all take action. Stop bullying – Freire style!

Aligning practice with policy to improve patient care

WITH GIULIANA & BILL RANCIC

By Sue MacInnes

50 The OR Connection I www.medline.com

Giuliana and Bill Rancic Inspire Audiences on

Several weeks ago, I had the pleasure of sitting down with Giuliana and Bill Rancic in their hometown of Chicago to talk about their latest project, spreading awareness about breast cancer prevention and the importance of early detection. As many of you know, Giuliana is a trusted journalist and noted fashionista. She is the anchor of E! News and the co-host of E!’s hugely popular Fashion Police team alongside Joan Rivers. Bill is an example of a true entrepreneur. As the winner of the first season of The Apprentice and, subsequently, Donald Trump’s right-hand man, he built cigarsaroundtheworld.com, a thriving multimillion dollar business. Today, he is a real estate developer in Chicago and a business mentor to others. Together, they are on a mission to inspire audiences nationwide with their story of love and determination through some of life’s most vulnerable moments.

Only 36 years old at the time, Giuliana had been asked by a fertility expert to undergo a mammogram as part of routine checklist of exams. Surprised by the request, she acquiesced, to avoid the risk of ending her relationship with the renowned fertility expert. To her absolute shock, her scan showed a malignant tumor, and so began her breast cancer journey. With the love and support of her new husband, Bill, they overcame breast cancer. Today, they have a beautiful baby boy and fresh outlook on life. Here is their story. Sue MacInnes: Can you each share your previous experience with breast cancer before Giuliana’s diagnosis? Giuliana Rancic: I really didn’t have much experience with breast cancer

before my diagnosis. My good friend Lindsay Avner started a breast cancer prevention and awareness nonprofit called Bright Pink that I was involved with, but other than that, I didn’t have much experience with breast cancer. Bill Rancic: Prior to Giuliana’s diagnosis I did not have much experience with breast cancer. I had friends and extended family members who had in one way or another been touched by the disease, but, this was a relatively new experience for me. SM: Giuliana, how did you find out you had breast cancer? Was it a long discovery process? GR: I found out that I had breast cancer from my doctor in Los Angeles. It actually all started in Denver, Colorado where I was beginning fertility treatments with a new doctor. Starting the new procedure required a current

Aligning practice with policy to improve patient care

mammogram, which I thought was crazy because I was only 36 years old at the time. I had to do it, and it was that mandatory mammogram that ended up saving my life. SM: Bill, what was your initial reaction? BR: My initial reaction was shock. I don’t think you can ever prepare yourself for a cancer diagnosis. SM: What were your treatment options? GR: Bill and I spent a lot of time researching every option. I had the option to do a double lumpectomy, double mastectomy and radiation or double mastectomy and years of medication. SM: What direction did you choose for treatment? Why? GR: My first procedure was the double lumpectomy. Jumping into a double mastectomy right off the bat was extremely terrifying, so we wanted to see how I would do after the lumpectomies. When the doctors told us that the margins weren’t clear following the lumpectomies, we ultimately decided to go ahead with a double mastectomy. I decided that I didn’t want to keep going back in for more and more surgeries and I didn’t want to keep looking over my shoulder every year for a return of the cancer. Bill and I spent

52 The OR Connection I www.medline.com

a lot of time praying and researching and ultimately decided that a double mastectomy was the best thing for me and for our family. SM: Bill, you played a significant role in supporting Giuliana. Tell us about the experience from your point of view. BR: I wanted to be there to support Giuliana through all aspects from the diagnosis to her treatment. I tried to distract her, make her laugh or just be there when she needed to cry. SM: The readership of The OR Connection is made up of operating room clinicians. Can you touch on the relationships you developed with your caregivers through all the different stages of your care? GR: I had so many wonderful caregivers that truly made a difference in my life. Cancer is such a scary thing and having the support of knowledgeable and gentle caregivers eased my worry. I still keep in touch with many of my doctors and nurses and will be forever grateful to them. SM: Is there anything specific you can share that enhanced your safety or the care you received? GR: Yes. Our terrific nurses were always on call for us and never felt like any question or concern we had was silly.

SM: Can you share with us a story or experience you might have had with a nurse or hospital caregiver while undergoing diagnosis or treatment? GR: I was so fortunate to have the best doctors and nurses in the world. My nurses were so kind and gentle, while still doing their jobs and that really put me at ease. It takes a very special person to be a nurse. SM: What is your message to the 1000 OR nurses that will be with us in San Diego? What do you want them to take away, to tell their families when they get home? GR: We would love them to know how appreciated they are even when they aren’t told by patients. A nurse can make or break a patient’s experience and the wonderful ones are never forgotten. SM: Have you thought about how you will explain your experience with breast cancer to your son, Duke, who in a sense saved your life during your fertility treatments? GR: Bill and I definitely plan to explain our experience with him some day. After all, it is his life story too! But for now, we are just enjoying every moment with him. BR: That seems so far away; right now we are still celebrating his birth and my health and are looking forward to him sleeping throughout the night. We do feel it will be important to share

that story with him one day but until then he will know what a blessing he is to us and how much he is loved. SM: Do you ever think about the “what ifs” regarding the way you found out you had breast cancer at such a young age? GR: I try to live my life without regret and I try not to dwell on the what-ifs. I truly feel that this whole experience was all part of a master plan and that Duke actually saved my life. There was a much bigger picture than infertility. For now, I am focusing on the future and living each day to the fullest. SM: Have you come across any research or information specifically directed toward women under 40 who are diagnosed with breast cancer? GR: I work very closely with a charity called Bright Pink, which focuses not only on breast cancer patients, but also on educating the public to bring awareness to prevention and early detection. If you or someone you know is scared to talk to your doctor, check out BrightPink.org for information and advice first. SM: The recommended age for a woman’s first mammogram is 40. Do you think the age should be younger? Do you have any advice for women under 40 who are worried about breast cancer?

GR: I think that women should be aware of their bodies and their health starting as early as their teens. Check yourself and educate yourself on what is or isn’t normal. Educating yourself is so important. A quick self exam might be enough to save your life. SM: We know you both have a very strong work ethic. What are you doing through your work to promote early detection of breast cancer? BR: I think whenever an opportunity presents itself (and sometimes when it doesn’t) we try to increase awareness and promote early detection. SM: Medline is proud to be based outside of Chicago. As a fellow Chicagoan, tell us about your Chicago roots and your connection to the area. How have your Chicago connections guided you in your career and your personal life? BR: I was born and raised in Chicago, and it will always be my home. The majority of my family is from Chicago, and I have a lot of friends who live in the city and suburbs. My Midwest roots have guided me in both large and small decisions I have had to make in my personal life and my career.

Aligning practice with policy to improve patient care

54 The ORâ&#x20AC;&#x2C6;Connection I www.medline.com

Want to achieve peak performance and lose weight?

Sleep more ... sleep better Wolf J. Rinke, PhD, RD, CSP

Aligning practice with policy to improve patient care

Researchers tell us that most of us do not get enough sleep. According to one estimate, 10 to 15 percent of Americans are suffering from chronic, long-term sleep deprivation, mostly insomnia and nightmares. The National Sleep Foundation maintains that Americans sleep almost two fewer hours a night than 40 years ago, with the average person sleeping far less than seven hours per night. Your reply—“so what, I’m doing just fine.” It may seem that way; however, research is telling us that to achieve peak performance, your body requires seven to nine hours. (That’s for most adults. Children, pregnant woman and older adults need more sleep.) Consistently sleeping less than seven to nine hours results in lower productivity, more accidents and higher levels of stress. For example, recent research at the University of Pennsylvania found that people who slept less than six hours a night had serious lapses in attention. Cognitive performance deficits included a reduced ability to pay attention and to react in a timely manner during such tasks as driving. Other deficits included the reduced ability to multi-task, to think quickly and to avoid making mistakes. Those lapses got worse as the week progressed. Getting six hours of sleep per night for two weeks was equivalent to staying up for 24 hours straight. Yet these subjects were not aware of how severely sleep deprived they actually were, putting themselves at even greater risk of harm. Plus a lack of sleep may also result in weight gain. (Yes, you read correctly!) New scientific evidence presented recently at a meeting of sleep researchers in Boston, found that sleep deprivation increases activity in areas of the brain that seek out pleasure— including that provided by high-calorie junk food. To make matters worse, sleepiness also seemed to dampen activity in other brain regions that usually serve to inhibit this type of craving. These latest findings, which are based on studies

using functional magnetic resonance imaging (fMRI), appear to affirm previous studies that established a link between sleep deprivation and obesity. And it’s not only the number of hours of sleep, it’s also the quality of your sleep. For example, during times of high stress, such as the period after 9/11, some people slept less well while others had sleep disturbing nightmares, or were unable to sleep at all. (The National Sleep Foundation found that over 75 percent of the people they surveyed after 9/11 experienced at least one sleep disorder several times a week.) Again, researchers have found that high levels of stress tend to disrupt the second half of a night’s sleep. And once you wake up at two or three in the morning, it’s difficult to fall back into a restful sleep. Inadequate amounts of restful, rejuvenating sleep will, according to the National Sleep Foundation, have a negative effect on your emotions, mood, memory, concentration and even your ability to make high quality decisions. Repeat that pattern several nights a week, and you will likely experience more severe effects such as feeling short-tempered, anxious or upset. It may even lead to depression. According to Timothy Roehrs, director of the Henry Ford Hospital of Sleep Disorders and Research Center in Detroit and the National Sleep Foundation, here are eight strategies that will enable you to get more quality ZZZZZZs. Continued on page 58

56 The OR Connection I www.medline.com

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Strategies to get more zzzzzz’s

Maintain a Regular Sleep Schedule To get the most from your sleep, go to bed and get up at approximately the same time, every day. Also, if you have insomnia, you may want to avoid napping. If you do feel you need a nap, take a powernap of no more than about 20 minutes. Although this is good advice, Superwoman (that’s my wife and business partner of over 40 years) and I allow ourselves the luxury of a short power nap on Saturday and sleeping in on Sundays. And why not? Some of the research evidence suggests that we are able to “store” some sleep.

Wind Down Be sure to create a wind-down phase before going to sleep. Stuff that really works well is reading, especially if it is a boring book, listening to soft music, meditating, cuddling with your partner, soaking in a warm bath or listening to music. What works like magic for us is television. Although I’m not a proponent of TV, I do advocate it as a tool for getting sleepy. When I’m at home, we typically read till about 9 pm. We tape the national news and our favorite shows—that way we can skip the commercials— and watch our favorite shows until we are ready to go to bed at about 11 pm. Then we read in bed until we get drowsy (usually about 15 minutes) and with any degree of luck, we have another restful night. Avoid exercising (see #8 below) arguing, scary movies or books, and TV news—especially the local news— right before going to sleep.

Get Out the “Blankie” Make your bed into a comfort zone, such as warm down blankets in the winter, fuzzy pajamas and your favorite pillow. Anything that gives you comfort, even your childhood “blankie.” (Hey, who’s going to know?) And while I’m thinking of it, don’t use your bed for anything else except the two S’s: sleep and sex.

Create a “Quiet” Zone Make sure your bedroom is as comfortable, calm, dark and quiet as you can make it. Install heavy curtains, shades, or double pane windows. If all else fails, get yourself a dark mask and a set of the gel type earplugs. Mack’s (wwwMacksEarplugs.com) work best for us. You may also want to try a soothing CD with very quiet mood music or the sound of a burbling brook.

Invest in a High-Quality Large Mattress Think about it. You spend a third of your life in bed. Marcela and I spent over 20 years of our married life on a full size mattress—not even a queen size. That just does not make any sense! (Hey who said I don’t do stupid stuff?) Now we sleep on a very spacious, soft, quality king size mattress. Because Marcela has been suffering with back problems, we tried a wide variety of mattresses, even one that was so hard they called it “Granite.” (I’m not making this up.) And what we finally found, after we wasted a lot of money, is that a soft, cushiony, spacious mattress works best for us. Continued on page 60

58 The OR Connection I www.medline.com

Program for Healthcare One-on-one sustainability guidance and services The greensmart approach for reaching your unique goals:

Measure Your Baseline

From calculations to benchmarking, your greensmart RoadMAP provides all the tools you need to green your OR, Housekeeping, Laundry, Food Services and Patient Rooms.

Receive One-on-one Consultation

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Identify Green Products and Strategies With the help of your Program Manager, you will identify products, services and education that are right for your facility.

Monitor and Promote You are given the tools to not only monitor your progress, but to promote your success.

One call starts you on your way to becoming greensmart Francesca Olivier, Medline’s corporate sustainability manager, is ready to work with you no matter where your facility is on your sustainability journey. Call her at (847) 643-3821 or email folivier@medline.com

©2013 Medline Industries, Inc. greensmart is a trademark and Medline is a registered trademark of Medline Industries, Inc. greensmart™ is not a third-party certification. The use of the greensmart™ trademark is determined by Medline Industries, Inc. through an internal review process of environmental claims.

Eat as Early as Possible Avoid eating before going to bed. In fact, eat your main meal as early as possible in the day. It will help with your weight-control, and enable you to sleep better at night. Also be sure to avoid high fat snacks, caffeine, nicotine and alcohol late in the day (after 7 pm).

Exercise Participate in a regular aerobic exercise program at least five days a week. Since it stimulates your metabolic rate, avoid this type of exercise three hours before going to bed.

Don’t Fight It If you find yourself unable to sleep for about 30 minutes, don’t fight it. Get up, get yourself a warm glass of milk (yes, it actually works), watch a boring TV program or read something that will calm you down. (That’s how I catch up on all my professional journals. They work like magic.) If all of this does not help you achieve restful sleep, you may have an underlying medical problem such as clinical depression, apnea or narcolepsy, and it’s time to see your doctor. © 2012 Wolf J. Rinke

60 The OR Connection I www.medline.com

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Fudgy Low Fat Brownies Everyone who visits Medline’s corporate headquarters in Mundelein, IL, is greeted with a warm smile from receptionist Lenore Czyznik. In this issue, she shares her recipe for tasty, gooey brownies that are lower in fat and calories. Enjoy! Directions

Adjust oven rack to middle position and heat oven to 350 degrees F. Fold two 12-inch pieces of foil lengthwise. Fit one sheet into an 8-inch square baking dish, pushing foil into corners and up sides of pan. (Overhang will help in removal of brownies after baking.) Repeat with second sheet of foil, placing it in the pan perpendicular to the first sheet. Spray foil with cooking spray. Whisk flour, cocoa, baking powder and salt together in a mixing bowl. Melt bittersweet chocolate and butter together in large bowl over a pan of simmering water until smooth.

The Medline employee cookbook is $10. To purchase your own copy, please e-mail Judy at jdesalvo@medline.com.

62 The OR Connection I www.medline.com

Ingredients ¾ cup all-purpose flour 1/3 cup Dutch processed cocoa powder ½ teaspoon baking powder ¼ teaspoon salt 2 ounces bittersweet chocolate, chopped 2 tablespoons unsalted butter 2 tablespoons low fat sour cream 1 tablespoon chocolate syrup 2 teaspoons vanilla extract 1 large egg plus 1 large egg white 1 cup sugar

Cool chocolate and butter mixture 2 to 3 minutes, then whisk in sour cream, chocolate syrup, vanilla, egg, egg white and sugar. Using rubber spatula, fold dry ingredients into chocolate mixture until combined. Pour batter into pan, spread into corners, and level surface with the spatula. Bake 20 to 25 minutes until slightly puffed and a toothpick in the center comes out with a few sticky crumbs attached. For a truly fudgy consistency, do not overbake. If the toothpick emerges with no crumbs, the brownies will be cakey.

Remove brownies from pan using foil handles. Cut into two-inch squares and serve. To keep brownies moist, do not cut until ready to serve. Brownies can be wrapped in plastic and refrigerated up to three days.

Forms & Tools

The following pages contain practical tools for implementing patient-focused care practices at your facility.

Surgical Site Infection Prevention

Take the Best Route to Preventing Surgical Site Infections in Hip and Knee Arthroplasty………………………………………………...64 Pre-op Bathing (Patient Handout)…………………………………………….67 Handoff Communication

SBAR Scenario Development Sheet………….……………………………69 SBAR Communication Tool………………………………………………….70

Aligning practice with policy to improve patient care

Forms & Tools

Surgical Site Infections

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                     

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Surgical Site Infections Forms & Tools 

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       

    

     

    

   

       

       

    

  Aligning practice with policy to improve patient care

Medline Safety Syringes

Protect yourself and your patients from needlestick injuries Don’t become a statistic A staggering 74 percent of nurses report being stuck by a contaminated needle,1 which can lead to infection with Hepatitis B and C, HIV, and other dangerous bloodborne pathogens. Slide the safety shield forward, twist, and when you hear the click, the syringe is safe for disposal.

To Prevent Transmission of Infections in Healthcare

Medline Safety Syringes: • Low dead-space design reduces waste • Easy-to-read bold markings • Insulin and tuberculin syringes available

Injection Safety is Every Provider’s Responsibility

See for yourself how Medline safety syringes protect and perform. Ask your Medline sales representative for a sample, or call 1-800-MEDLINE.

Reference 1. American Nurses Association. 2008 Study of Nurses’ Views on Workplace Safety and Needlestick Injuries. Available at: http://nursingworld.org/MainMenuCategories/WorkplaceSafety/SafeNeedles/2008-Study/2008InviroStudy.pdf. Accessed March 16, 2012.

Patient Handout - Pre-op Bathing

Forms & Tools

 Apply  Lather  Rinse  REPEAT  REPEAT  REPEAT

Surgical site infections can be

prevented. Ask your surgeon about the importance of showering or bathing with chlorhexidine soap daily for 3 days before surgery.

   Your logo here           



Aligning practice with policy to improve patient care

The OR Goes Green – the first and only bio-based surgical drape Medline’s EcoDrape is the only bio-based surgical drape available today. It’s made of more than 96% wood pulp and has all the same great features and performance as other Medline drapes, including hook-and-loop line holders, large reinforcement zones, and premium tape and incise film flush to the fenestration. Try the new EcoDrape and take your OR to the next level of green!

Composition Comparison EcoDrape SMS

Fibers

More than 96% wood pulp

Petrochemical 0% ingredients (plastics) Additives

No wood pulp 100% Polypropylene

Bio-based Fluorine

For a quick online video demonstration, visit www.medline.com/ecodrape

FOR AN ONLINE VIDEO DEMONSTRATION ABOUT MEDLINE’S ECODRAPE Scan this QR Code or visit www.medline.com/ecodrape

greensmart™ is not a third-party certification. The use of the greensmart™ trademark is determined by Medline Industries, Inc. through an internal review process of environmental claims. ©2013 Medline Industries, Inc. Medline is a registered trademark of Medline Industries, Inc. EcoDrape and greensmart are trademarks of Medline Industries, Inc.

Narrative without S - B - A - R

Using S - B - A - R

Aligning practice with policy to improve patient care

SSC SBAR Practice Sheet

ďŁŠ 2004 Kaiser Foundation Health Plan, Inc. Kaiser Foundation Health Plan, Inc. is the owner and holds the copyright of the material(s) and must be acknowledged in all print and electronic media as the original developer and copyright holder of the material(s).

Recommendation

Assessment

Background

Situation

Item

Scenario Development Sheet

S - B - A - R Communication Tool

PCA Patient Safety Checklist Forms & Tools

70 The ORâ&#x20AC;&#x2C6;Connection I www.medline.com

Details that give information to make an assessment. (Can be from patient's view and from your clinical view as you inquire and research)

Your position on the issue

Your specific method for solving the problem

Background

Assessment

Recommendation

I recommend that we use the 1+ time or have your hall partner see this patient.

We should see the patient today

1. Patient arrived for 11 am appointment today. 2. Appointment is at 11 am tommorrow 3. Pt. Comes from 40 miles away 4. Pt. Needed to have friend drive them to appointment 5. Doctor has 1+ appointment available on schedule 6. Doctor's hall partner has some open times 7. We don't know if the mistake was with the patient or the call center

Patient arrived for appoint on wrong day

Example

SSC SBAR Communication Tool Definitions 7/7/2004

One sentence description of need

Definition

Situation

Item

S - B - A - R Communication Tool

Forms & Tools PCA Patient Safety Checklist

SIMPLIFIED TO SAVE YOU TIME

ERASE CAUTI

LEARN MORE ABOUT THE ERASE CAUTI SYSTEM www.erasecauti.com

Aligning practice with policy to improve patient care

NEW!

You’ll never see packs the same again. Organized. Efficient. Simple.

The purpose of surgical procedure packs is to bring convenience to your world. Yet every blue pack looks almost identical to every other pack – resulting in needless confusion and costly mistakes. Wrong packs are pulled more often than you might think - causing the extra work and expense of pulling separate sterile items. Or, worse yet, discarding the entire wrong pack and replacing it with the correct one. Furthermore, when looking at the pack insert, it's difficult to identify important information such as its contents, expiration date or if any of the contents contains latex. Recognizing these problems, Medline set out to eliminate pack confusion. The result: Medline’s EMPOWER Packaging System – an entirely new and streamlined way of looking at packs.

Turn to page 22 for the complete story behind the innovative design!

Visit us at AORN Booth #2710

MKT1324571 / LIT659 / 25M / JBK5